Medicaid changes will be tough sell

GOP, governor outspokenly against expansion of program

Democratic legislators likely face insurmountable hurdles this year in the Legislature as they continue the push to get health care coverage for nearly 250,000 people in Louisiana, mostly uninsured workers.

They are up against a Republican governor and a majority GOP Legislature solidly against expanding Medicaid as part of the federal Affordable Care Act, known as Obamacare.

Under a ruling by the U.S. Supreme Court, states can opt in or out of the Medicaid expansion part of Obamacare. Gov. Bobby Jindal opted out early on, saying Medicaid is a broken system and the state cannot afford it.

Democrats hit a wall in the 2013 Legislature in their efforts to reverse Jindal’s decision. And there’s no indication that positions have changed since then.

But a handful of legislators are ready to do battle again.

“You know it seems as if one day the climate is improved, the next day it’s declining. I do think that the debate is necessary. If you look at it just from an economic standpoint, I can’t see anything but good things happening two or three years out,” said state Sen. Ben Nevers, D-Bogalusa.

The federal government is fully funding the health care coverage for people with incomes less than 138 percent of the federal poverty level — about $32,000 for a family of four — for the first three years and is to pay no less than 90 percent of the bills after that.

Nevers says that would translate into health care to improve people’s lives in the state and a boost of billions of dollars flowing into the Louisiana economy . The federal government would infuse an estimated $18.5 billion over the next decade, while the state would have to put up an estimated $1.8 billion, Nevers said.

“We are just trying to see what we can do to get folks insured,” said state Rep. Patricia Smith, D-Baton Rouge. “The biggest thing is we have to continue to push the issue and make sure people are aware of the number of people not going to be getting health insurance.”

State Senate Health and Welfare Committee Chairman David Heitmeier said he does not like to say anything is impossible, then qualifies the statement with a “but,” considering that the Jindal administration’s Department of Health and Hospitals would be the authorizing agency for the Medicaid expansion in Louisiana.

“With that being a given, we would have to ask the governor his position — and I think he has been very clear on this,” said Heitmeier, D-New Orleans.

Meanwhile, a Republican legislator and a lawmaker unaffiliated with a political party are pursuing legislation to force Louisiana to disavow anything to do with the Affordable Care Act.

State Rep. Dee Richard, no party-Thibodaux, filed a bill that would bar the state from enforcing the federal health care revamp. He calls it the “Louisiana Freedom of Health Care Protection Act.”

“I believe in states’ rights,” said Richard. “I think we have the right of a state to do that. ... Other states have done it.”

State Rep. Paul Hollis, R-Mandeville, is seeking a three-year moratorium on state implementation or enforcement. He also filed legislation to create a special fund to educate Louisiana residents on ways to opt out of Obamacare.

Nevers said he continues to be driven by the calls he gets about people who are uninsured and not qualified for Medicaid.

The Affordable Care Act envisioned people making below 138 percent of the federal poverty level receiving Medicaid under the program’s expansion, so it doesn’t subsidize insurance premiums for them. Because Louisiana did not expand Medicaid, a whole group of people with household income below the federal poverty level who do not qualify for the existing Medicaid program are left unable to afford insurance.

Nevers is proposing two constitutional amendments and one statutory change. Smith said her bills are patterned after those filed by Nevers, who is taking the lead on Medicaid expansion efforts. Constitutional amendments require a two-thirds vote of the Legislature then go to the voters for approval — bypassing the governor. Statutory changes require a majority vote of the Legislature and approval by the governor.

One constitutional amendment would require the state Department of Health and Hospitals to administer a state program that provides insurance for essential health benefits to legal residents whose income is at or below 138 percent of the federal poverty level. It would not tie the agency to a specific way of doing so, leaving open the option of a private insurance-based plan, such as one adopted in Arkansas.

The constitutional proposition would still allow the state to bow out of the Medicaid expansion if federal funding dips below 90 percent.

A statutory law change would require the state health agency to create and administer a program that either expands Medicaid eligibility to 138 percent of the federal poverty level or provides for some alternative health insurance program serving the same group of people. It also provides a way for the state to get out of the program if federal financial participation falls below 90 percent. Nevers calls it the “La. Health Care Independence Program.”

The second constitutional amendment proposed by Nevers would require the state to provide health insurance for legal residents who work for an employer in the state for at least 1,000 hours in the previous calendar year and whose income is below 100 percent of the federal poverty level. The proposition would capture many of those who fall in the insurance coverage gap as a result of state rejection of the Medicaid expansion.

Nevers said the funds for that type of expansion would probably have to come out of the state general fund. There is no option in federal law to expand for just part of the population with incomes below 138 percent of poverty so there would be no federal funding for such a move.

“Some people want to insure only those employed. We will see what happens,” he said.

Proposed constitutional amendments require a two-thirds vote in both the House and Senate before they can be submitted to voters for approval.

“The question is whether the Legislature has the will to let the people decide,” he added. “I’m willing to accept what the people decide.”

State Rep. John Bel Edwards, D-Amite, goes a different route in his Medicaid expansion quest. He filed a joint resolution under which the Legislature amends Louisiana’s Medicaid eligibility rules to conform with standards in the federal act. Resolutions require a majority vote for passage.

House Clerk Butch Speer said if the Legislature passes a concurrent resolution in which it states lawmakers are amending an administrative law, unless someone takes them to court, it is presumed valid. Resolutions do not go to the governor for action.